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EP1744690A1 - Intervertebral implant - Google Patents

Intervertebral implant

Info

Publication number
EP1744690A1
EP1744690A1 EP05769961A EP05769961A EP1744690A1 EP 1744690 A1 EP1744690 A1 EP 1744690A1 EP 05769961 A EP05769961 A EP 05769961A EP 05769961 A EP05769961 A EP 05769961A EP 1744690 A1 EP1744690 A1 EP 1744690A1
Authority
EP
European Patent Office
Prior art keywords
parts
clipping
assembly
guide
face
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
EP05769961A
Other languages
German (de)
French (fr)
Other versions
EP1744690B1 (en
Inventor
Régis Le Couedic
Denis Pasquet
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Zimmer Spine SAS
Original Assignee
Zimmer Spine SAS
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Zimmer Spine SAS filed Critical Zimmer Spine SAS
Publication of EP1744690A1 publication Critical patent/EP1744690A1/en
Application granted granted Critical
Publication of EP1744690B1 publication Critical patent/EP1744690B1/en
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7062—Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
    • A61B17/7068—Devices comprising separate rigid parts, assembled in situ, to bear on each side of spinous processes; Tools therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7053—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant with parts attached to bones or to each other by flexible wires, straps, sutures or cables
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs

Definitions

  • the present invention relates to an intervertebral implant for the current part of the spine, and more particularly the wedge of the implant.
  • Intervertebral wedges are well-known devices which are placed between two adjacent vertebrae to join these two vertebrae together and maintain a fixed interval between them.
  • French patent application 01 03362 in the name of the applicant describes such wedges. It suffices to recall that the wedge is provided at each of its ends with a notch in which the spinous process of the vertebra engages.
  • a system of links or braids allows to secure each end of the wedge with the thorny.
  • the installation of such a wedge raises certain problems associated with surgical practice. Indeed, a ligament, called supra spiny, connects all the vertices of the spinous processes between them.
  • Each part of the wedge is put in place by bypassing the supraspinous ligament and then using suitable surgical instruments, the two parts of the wedge are secured.
  • Such two-part shims are described in particular in US Pat. No. 6,156,038.
  • the two-part shims described in this document are of relatively delicate use.
  • the assembly of the two parts of the wedge in situ is relatively delicate and it is not sure to obtain the assembly of the two parts forming the wedge in a suitable manner.
  • An object of the present invention is to provide an intervertebral wedge consisting of two separate parts whose assembly is easier for the surgeon during the intervention.
  • the intervertebral implant comprising a wedge constituted by a first and a second part, said parts being provided with mutual assembly means
  • said assembly means comprise: - first clipping means secured to one of said pieces, - second clipping means secured to the other piece, capable of cooperating with the first clipping means to achieve a clipping-open of the two pieces in a clipping direction, said first and second clipping means forming an integral part of said two parts; and - means for guiding the two parts when they are clipped, said guide means being distinct from the clipping means and comprising: .. a first guide assembly integral with one of said parts and substantially non-deformable; and ..
  • each piece constituting the intervertebral wedge comprises, on the one hand, guide means and on the other hand, clip means
  • the guide means ensure the relative positioning of the clip means so rigorous and easy for the surgeon. This ensures the correct assembly of the two parts constituting the shim and moreover, this operation can be carried out more quickly than with the shims of the prior art.
  • the clipping means are an integral part of the two parts, the placement of the implant by the surgeon is facilitated.
  • each part of the wedge has an assembly face intended to be applied against that of the other part when the two parts are assembled.
  • the guide means consist respectively of two guide pins protruding from one of the assembly faces and by two recesses opening into the assembly face of the other part. This gives effective guidance of one piece with respect to the other by giving the guide pins a suitable shape.
  • FIG. 1 is an exploded view of the various elements constituting the intervertebral implant
  • - Figure 2 is a view of the assembly face of one of the two parts constituting the intervertebral wedge
  • - Figure 3 is a side view of the wedge after the assembly of the two parts constituting it
  • - Figure 4 is a longitudinal section of the self-locking element used to secure the braids of the implant.
  • the two parts 12 and 14 are shown, the assembly of which makes it possible to obtain the intervertebral wedge 10.
  • a removable element 16 used for fixing and tightening the braids ensuring the joining of the two spinous processes on the hold. This fixing element 16 will be described later.
  • the part 12 constitutes a first flank of the intervertebral wedge.
  • This part 12 has an internal face 12a and an external face 12b.
  • the internal face 12a defines an upper support surface 20, a lower support surface 22 and a middle assembly face 24.
  • the second part 14 also constitutes a sidewall 26 having an internal face 26a facing the internal face 12a of the part 12 and an external face 26b.
  • the internal face 26a of the sidewall 26 defines an upper support surface 28 and a lower support surface 30.
  • the part 14 has a projection 32 which projects into the central part of face 26a. This projection 32 or spacer defines two respectively upper 34 and lower 36 bearing faces, these two faces being substantially parallel.
  • the spacer 32 may have transverse recesses such as 38 to give this part of the wedge a certain elasticity.
  • the free end of the spacer 32 defines an assembly face 40 intended to come to bear on the assembly face 24 of the part 12 when the two parts constituting the wedge are assembled.
  • mutual guide means are provided during the bringing together of these two parts with a view to their joining.
  • these guide means consist of two guide pins 42 and 44 projecting from the assembly face 40 of the part 14 and by two blind recesses 46 and 48 formed in the assembly face 24 of the part 12. We would not go beyond the invention if we planned a single pawn and a single recess.
  • the ends of the assembly pins 42 and 44 are conical to ensure the initial positioning of the two parts.
  • the attachment of the parts 12 and 14 is obtained by clipping means which are produced respectively in the lateral faces 12c and 12d of the part 12, and in the lateral faces 32a and 32b of the projection 32 of the part 14.
  • These means of clipping for example for part 12, consists of two pairs of cylindrical pins 49 and 50 and in two flanks projecting beyond the assembly face 44 of part 14, respectively referenced 51 and 52.
  • Each flank is provided two openings 54 and 56 adapted to receive the pins 49 and 50 during the clipping.
  • Each orifice 54, 56 has a deformable spoiler 58 and 60.
  • the pins 49 and 50 protrude into a recess 60 produced in the lateral faces 12c, 12d of the part 12.
  • the guide pins 42 and 44 have a length which is greater than that of the sides 51 and 52 defining the female clip elements. Whatever the particular embodiment of the clipping means, these form an integral part of the two parts 12 and 14 respectively. As best shown in FIG. 3, when the parts 12 and 14 are assembled, in the manner in which the 'will explain later, we obtain an intervertebral wedge having the usual structure.
  • the bearing faces 20, 22 of the part 12 as well as the bearing faces 28, 30 of the sidewall 26 of the part 14 and finally the upper 34 and lower 36 faces of the extension 32 define two recesses 62 and 64 intended to receive the spinous processes of the two vertebrae between which the wedge is disposed.
  • the guide pins 42 and 44 have a length which is greater than that of the sides 50 and 52 defining the female clipping elements.
  • the mode of use of the wedge described above is as follows. The surgeon sets up, bypassing the supraspinous ligament, the parts 12 and 14 constituting the wedge. With the aid of suitable surgical instruments, it brings the two parts together to make the guide pins 42 and 44 cooperate with the guide recesses 46 and 48.
  • the clipping members 48, 50 and 54, 56 are opposite each other. It suffices for the surgeon to exert pressure on the external faces of the two parts to cause the clipping of the parts 12 and 14, and therefore obtaining the complete shim 10. It should be added that the clipping elements 48, 50 and 54, 56 are made in such a way that they ensure effective clipping but that it is possible to desendip them in the event that it is necessary to change the shim. As can be seen, the positioning of the wedge is easy since it only comprises two parts. Referring now to Figures 1 and 4, we will describe a preferred embodiment of the securing means of the wedge 10 and the spinous processes of the vertebrae.
  • This joining system is constituted by the blocking or joining piece 16 and by two braids T1 and T2.
  • the connecting piece 16 can be fixed on the external face 26b of the piece 14 by clipping means 80, 82, 84 and 86 which are identical to the clipping means of the pieces 12 and 14.
  • the fixing piece 16 has a face 16b on the part 14 and an external face 16a.
  • the fixing piece 16 has a plane of symmetry P, P 'orthogonal to the faces 16a and 16b and parallel to the faces 32 and 34 of the extension 30 of the piece 14.
  • the locking piece 16 has a central slot 90 which opens into the two faces of the part 16 and two symmetrical inclined lateral slots 92 and 94 which also open into the two faces of the part 16.
  • the clipping face 16b of the part 16 has two recessed surfaces 96 and 98 which extend between respectively the lateral slots 92 and 94 and the upper and lower ends of the part 16 which constitute braid tightening surfaces.
  • the slot 92 and the recessed surface 98 define a first edge 100.
  • the slot 92 with the external face 16a of the part 16 define a second acute edge 102 parallel to the edge 100.
  • the edge 102 is further from the median plane P, P 'than the edge 100.
  • each braid T1 and T2 comprises a first end A which is integral with the part 12.
  • the part 12 is provided with an upper slot 104 and a lower slot 106 in which the ends A braids can form a loop. After sewing this loop, the braids Tl and T2 are effectively secured at each end of the part 12. The braid T2 is engaged between the surface 98 and the face 26b of the wedge then in the central slot 90.
  • the braid T2 is engaged below the pressure surface 98, between the first strand of that same braid and that surface.
  • the braid Tl is of course engaged in the part 16 in the same way to ensure the connection with the spinous process of the other vertebra. It is understood that the securing piece 16 forms for each braid a self-locking system.
  • the first clipping means comprise at least two male clipping members 54 and 56 substantially non-deformable, arranged on either side of the assembly surface 24 and the second clipping means comprise at least two female members 49 and 50 for elastically deformable clipping arranged on either side of the assembly surface 40.
  • said first guide assembly comprises at least one guide pin 42 and 40 projecting in one face d 'assembly 40 of one of the parts and at least one recess 46 and 48 opening into the assembly face 24 of the other part.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Neurology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • General Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Public Health (AREA)
  • Animal Behavior & Ethology (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Vascular Medicine (AREA)
  • Prostheses (AREA)

Abstract

The invention relates to an intervertebral implant comprising a wedge consisting of a first (12) and second (14) piece, said pieces being provided with mutual assembly means comprising first clipping means (54, 56) which are coupled to one of the pieces; second clipping means (49, 50) which are coupled to the other part, said means being able to cooperated with the first clipping means in order to clip the two parts in an unclippable manner; and means for guiding the two parts (12,14) when they are clipped and comprising: a first guiding set (42,44) which is coupled to one of the pieces and which is substantially non deformable; and a second guiding set (46,48), which is coupled to the other piece and which is substantially non-deformable, in order to cooperate with the first guiding set.

Description

IMPLANT INTERVERTEBRAL La présente invention a pour objet un implant intervertébral pour la partie courante de la colonne vertébrale, et plus particulièrement la cale de l'implant. Les cales intervertébrales sont des dispositifs bien connus qui sont placés entre deux vertèbres adjacentes pour solidariser ces deux vertèbres et maintenir entre celles-ci un intervalle fixe. La demande de brevet français 01 03362 au nom du demandeur décrit de telles cales. Il suffit de rappeler que la cale est munie à chacune de ses extrémités d'une échancrure dans laquelle vient s'engager l'apophyse épineuse de la vertèbre. Un système de liens ou de tresses permet de solidariser chaque extrémité de la cale avec l'épineuse. Cependant, la mise en place d'une telle cale soulève certains problèmes liés à la pratique chirurgicale. En effet, un ligament, dit supra épineux, relie tous les sommets des apophyses épineuses entre eux. Pour mettre en place la cale, il faut déplacer ce ligament. Pratiquement, on le détache des deux apophyses concernées et on l'écarté au moyen d'un instrument chirurgical approprié. Pour détacher le ligament des épineuses, on utilise un scalpel. Une fois que la cale est mise en place, on recoud le ligament aux épineuses après avoir pratiqué une petite ouverture dans ces dernières pour placer le fil de couture. L'inconvénient majeur de cette pratique chirurgicale est qu'en touchant au ligament pour le détacher puis l'écarter, on lui fait perdre ses propriétés mécaniques. De plus, toutes ces opérations nécessitent du temps qui augmente la durée de l'intervention chirurgicale. Pour remédier à cet inconvénient, on a déjà proposé des cales intervertébrales constituées par deux parties distinctes. Chaque partie de la cale est mise en place en contournant le ligament supra épineux puis à l'aide d'instruments chirurgicaux adéquats, on solidarise les deux parties de la cale. De telles cales en deux parties sont notamment décrites dans le brevet US 6 156 038. Cependant, les cales en deux parties décrites dans ce document sont d'une utilisation relativement délicate. En particulier, l'assemblage des deux parties de la cale in situ est relativement délicat et il n'est pas sûr d'obtenir l'assemblage des deux pièces formant la cale de façon convenable. Un objet de la présente invention est de fournir une cale intervertébrale constituée par deux pièces distinctes dont l'assemblage soit plus aisé pour le chirurgien lors de l'intervention. Pour atteindre ce but, selon l'invention, l'implant intervertébral comprenant une cale constituée par une première et une deuxième pièce, lesdites pièces étant munies de moyens d'assemblage mutuel, se caractérise en ce que lesdits moyens d'assemblage comprennent : - des premiers moyens de clipsage solidaires d'une desdites pièces, - des deuxièmes moyens de clipsage solidaires de l'autre pièce, aptes à coopérer avec les premiers moyens de clipsage pour réaliser un clipsage désenclipsable des deux pièces selon une direction de clipsage, lesdits premiers et deuxièmes moyens de clipsage faisant partie intégrante desdites deux pièces ; et - des moyens de guidage des deux pièces lors de leur enclipsage, lesdits moyens de guidage étant distincts des moyens de clipsage et comprenant : .. un premier ensemble de guidage solidaire d'une desdites pièces et sensiblement non déformable ; et .. un deuxième ensemble de guidage solidaire de l'autre pièce et sensiblement non déformable, pour coopérer avec le premier ensemble de guidage afin de réaliser un guidage mutuel des deux pièces selon ladite direction de clipsage et un positionnement relatif des deux pièces dans un plan orthogonal à la direction de clipsage. On comprend que, grâce au fait que chaque pièce constituant la cale intervertébrale comporte, d'une part, des moyens de guidage et d'autre part, des moyens de clipsage, les moyens de guidage assurent le positionnement relatif des moyens de clipsage de façon rigoureuse et de manière aisée pour le chirurgien. On assure ainsi le bon assemblage des deux pièces constituant la cale et de plus, cette opération peut être réalisée plus rapidement qu'avec les cales de l'état de la technique. En outre, comme les moyens de clipsage font partie intégrante des deux pièces, la mise en place.de l'implant par le chirurgien est facilitée. Selon un mode préféré de réalisation de l'invention, chaque pièce de la cale comporte une face d'assemblage destinée à être appliquée contre celle de l'autre pièce lorsque les deux pièces sont assemblées. De préférence encore, les moyens de guidage sont constitués respectivement par deux pions de guidage faisant saillie hors d'une des faces d'assemblage et par deux évidements débouchant dans la face d'assemblage de l'autre pièce. On obtient ainsi un guidage efficace d'une pièce par rapport à l'autre en donnant aux pions de guidage une forme convenable. D'autres caractéristiques et avantages de l'invention apparaîtront mieux à la lecture de la description qui suit d'un mode de réalisation de l'invention donné à titre d'exemple non limitatif. La description se réfère aux figures annexées sur lesquelles : - la figure 1 est une vue éclatée des différents éléments constituant l'implant intervertébral ; - la figure 2 est une vue de la face d'assemblage d'une des deux pièces constituant la cale intervertébrale ; - la figure 3 est une vue de côté de la cale après l'assemblage des deux pièces la constituant ; et - la figure 4 est une coupe longitudinale de l'élément d'auto-blocage servant à solidariser les tresses de l'implant. Sur la figure 1, on a représenté les deux pièces 12 et 14 dont l'assemblage permet d'obtenir la cale intervertébrale 10. Sur cette figure, on a également représenté un élément amovible 16 servant à la fixation et au serrage des tresses assurant la solidarisation des deux apophyses épineuses sur la cale. Cet élément de fixation 16 sera décrit ultérieurement. La pièce 12 constitue un premier flanc de la cale intervertébrale. Cette pièce 12 comporte une face interne 12a et une face externe 12b. La face interne 12a définit une surface d'appui supérieure 20, une surface d'appui inférieure 22 et une face d'assemblage médiane 24. La deuxième pièce 14 constitue également un flanc 26 présentant une face interne 26a tournée vers la face interne 12a de la pièce 12 et une face externe 26b. La face interne 26a du flanc 26 définit une surface supérieure d'appui 28 et une surface inférieure d'appui 30. Dans la région médiane de la face interne du flanc 26, la pièce 14 comporte une projection 32 qui fait saillie dans la partie centrale de la face 26a. Cette projection 32 ou pièce d'espacement définit deux faces d'appui respectivement supérieure 34 et inférieure 36, ces deux faces étant sensiblement parallèles. La pièce d'écartement 32 peut comporter des évidements transversaux tels que 38 pour conférer à cette partie de la cale une certaine élasticité. L'extrémité libre de la pièce d'écartement 32 définit une face d'assemblage 40 destinée à venir en appui sur la face d'assemblage 24 de la pièce 12 lorsque les deux pièces constituant la cale sont assemblées. Dans les faces d'assemblage 40 et 24 des deux pièces, sont prévus des moyens de guidage mutuel lors du rapprochement de ces deux pièces en vue de leur solidarisation. De préférence, ces moyens de guidage sont constitués par deux pions de guidage 42 et 44 faisant saillie hors de la face d'assemblage 40 de la pièce 14 et par deux évidements borgnes 46 et 48 ménagés dans la face d'assemblage 24 de la pièce 12. On ne sortirait pas de l'invention si on prévoyait un seul pion et un seul évidement. De préférence, comme cela est en soi connu, les extrémités des pions d'assemblage 42 et 44 sont coniques pour assurer le positionnement initial des deux pièces. La solidarisation des pièces 12 et 14 est obtenue par des moyens de clipsage qui sont réalisés respectivement dans les faces latérales 12c et 12d de la pièce 12, et dans les faces latérales 32a et 32b de la projection 32 de la pièce 14. Ces moyens de clipsage consistent, par exemple pour la pièce 12, en deux paires de tétons cylindriques 49 et 50 et dans deux flancs faisant saillie au- delà de la face d'assemblage 44 de la pièce 14, respectivement référencés 51 et 52. Chaque flanc est muni de deux ouvertures 54 et 56 aptes à recevoir les tétons 49 et 50 lors de l'enclipsage. Chaque orifice 54, 56 comporte un becquet déformable 58 et 60. Comme le montre également la figure 1, les tétons 49 et 50 font saillie dans un évidement 60 réalisé dans les faces latérales 12c, 12d de la pièce 12. Il faut ajouter que bien entendu, les pions de guidage 42 et 44 ont une longueur qui est supérieure à celle des flancs 51 et 52 définissant les éléments femelles de clipsage. Quelque soit le mode particulier de réalisation des moyens de clipsage, ceux-ci font partie intégrante respectivement des deux pièces 12 et 14. Comme le montre mieux la figure 3, lorsque les pièces 12 et 14 sont assemblées, de la manière qu'on l'expliquera ultérieurement, on obtient une cale intervertébrale ayant la structure habituelle. En particulier, les faces d'appui 20, 22 de la pièce 12 ainsi que les faces d'appui 28, 30 du flanc 26 de la pièce 14 et enfin les faces supérieure 34 et inférieure 36 de l'extension 32 définissent deux évidements 62 et 64 destinés à recevoir les apophyses épineuses des deux vertèbres entre lesquels la cale est disposée. Il faut ajouter que bien entendu, les pions de guidage 42 et 44 ont une longueur qui est supérieure à celle des flancs 50 et 52 définissant les éléments femelles de clipsage. Le mode d'utilisation de la cale décrite précédemment est le suivant. Le chirurgien met en place, en contournant le ligament supra épineux, les pièces 12 et 14 constituant la cale. A l'aide d'instruments chirurgicaux adaptés, il rapproche les deux pièces pour faire coopérer les pions de guidage 42 et 44 avec les évidements de guidage 46 et 48. Lorsque le positionnement relatif qui en résulte est réalisé, les organes de clipsage 48, 50 et 54, 56 sont en regard les uns des autres. Il suffit pour le chirurgien d'exercer une pression sur les faces externes des deux pièces pour provoquer le clipsage des pièces 12 et 14, et donc l'obtention de la cale complète 10. Il faut ajouter que les éléments de clipsage 48, 50 et 54, 56 sont réalisés de telle manière qu'ils assurent un clipsage efficace mais qu'il soit possible de les desendipser dans le cas où il serait nécessaire de procéder au changement de la cale. Comme on le voit, la mise en place de la cale est aisée puisque celle-ci ne comprend que deux pièces. En se référant maintenant aux figures 1 et 4, on va décrire un mode préféré de réalisation des moyens de solidarisation de la cale 10 et des apophyses épineuses des vertèbres. Ce système de solidarisation est constitué par la pièce de blocage ou de solidarisation 16 et par deux tresses Tl et T2. La pièce de solidarisation 16 peut être fixée sur la face externe 26b de la pièce 14 par des moyens de clipsage 80, 82, 84 et 86 qui sont identiques aux moyens de clipsage des pièces 12 et 14. La pièce de fixation 16 présente une face de clipsage 16b sur la pièce 14 et une face externe 16a. La pièce de fixation 16 présente un plan de symétrie P, P' orthogonal aux faces 16a et 16b et parallèle aux faces 32 et 34 de l'extension 30 de la pièce 14. La pièce de blocage 16 comporte une fente centrale 90 qui débouche dans les deux faces de la pièce 16 et deux fentes latérales inclinées symétriques 92 et 94 qui débouchent également dans les deux faces de la pièce 16. La face de clipsage 16b de la pièce 16 présente deux surfaces en retrait 96 et 98 qui s'étendent entre respectivement les fentes latérales 92 et 94 et les extrémités supérieure et inférieure de la pièce 16 qui constituent des surfaces de serrage des tresses. La fente 92 et la surface en retrait 98 définissent une première arête 100. De même, la fente 92 avec la face externe 16a de la pièce 16 définissent une deuxième arête aiguë 102 parallèle à l'arête 100. Comme le montre la figure, l'arête 102 est plus éloignée du plan médian P, P' que l'arête 100. En outre, il faut préciser que les surfaces de serrage 96 et 98 sont disposées de telle manière que lorsque la pièce 16 est clipsée sur la cale, la distance entre la face 26b de la cale et la surface 96 ou 98 soit légèrement inférieure à deux fois l'épaisseur des tresses Tl et T2. Chaque tresse Tl et T2 comprend une première extrémité A qui est solidaire de la pièce 12. Pour cela, dans l'exemple considéré, la pièce 12 est munie d'une fente supérieure 104 et d'une fente inférieure 106 dans lesquelles les extrémités A des tresses peuvent former une boucle. Après couture de cette boucle, on obtient effectivement la solidarisation des tresses Tl et T2 à chaque extrémité de la pièce 12. La tresse T2 est engagée entre la surface 98 et la face 26b de la cale puis dans la fente centrale 90. Ensuite, elle passe sur une portion de la face externe 16a de la pièce 16 et pénètre dans la fente 92 en passant en regard de l'arête 102. Ensuite, la tresse T2 est engagée en dessous de la surface de pression 98, entre le premier brin de cette même tresse et cette surface. Lorsque le chirurgien exerce une traction sur l'extrémité B de la tresse T2, cela permet d'assurer le serrage de la tresse T2 sur l'apophyse épineuse de la vertèbre supérieure ou inférieure. La tresse Tl est bien sûr engagée dans la pièce 16 de la même manière pour assurer la liaison avec l'apophyse épineuse de l'autre vertèbre. On comprend que la pièce de solidarisation 16 forme pour chaque tresse un système autobloquant. Lorsque le chirurgien exerce une traction sur l'extrémité libre B de la tresse, celle-ci peut se déplacer sans frottement excessif dans les fentes 90 et 92 jusqu'à ce que l'on obtienne l'effet de serrage souhaité. En revanche, lorsqu'aucune traction n'est exercée sur l'extrémité B de la tresse, c'est-à-dire en utilisation normale de l'implant intervertébral, un effet d'autoblocage est obtenu grâce à la présence des arêtes 100 et 102 et à l'effet de serrage de la surface de pression 98 sur les deux brins de la tresse. Selon un mode préféré de réalisation, les premiers moyens de clipsage comprennent au moins deux organes mâles de clipsage 54 et 56 sensiblement non déformables, disposés de part et d'autre de la surface d'assemblage 24 et les deuxièmes moyens de clipsage comprennent au moins deux organes femelles 49 et 50 de clipsage elastiquement deformables disposés de part et d'autre de la surface d'assemblage 40. De préférence également, ledit premier ensemble de guidage comprend au moins un pion de guidage 42 et 40 faisant saillie dans une face d'assemblage 40 d'une des pièces et au moins un évidement 46 et 48 débouchant dans la face d'assemblage 24 de l'autre pièce. The present invention relates to an intervertebral implant for the current part of the spine, and more particularly the wedge of the implant. Intervertebral wedges are well-known devices which are placed between two adjacent vertebrae to join these two vertebrae together and maintain a fixed interval between them. French patent application 01 03362 in the name of the applicant describes such wedges. It suffices to recall that the wedge is provided at each of its ends with a notch in which the spinous process of the vertebra engages. A system of links or braids allows to secure each end of the wedge with the thorny. However, the installation of such a wedge raises certain problems associated with surgical practice. Indeed, a ligament, called supra spiny, connects all the vertices of the spinous processes between them. To set up the wedge, you have to move this ligament. In practice, it is detached from the two processes concerned and it is removed using an appropriate surgical instrument. To detach the ligament from the thorns, a scalpel is used. Once the wedge is in place, the ligament is stitched back to the thorny trees after having made a small opening in them to place the sewing thread. The major drawback of this surgical practice is that by touching the ligament to detach it and then move it aside, it makes it lose its mechanical properties. In addition, all these operations require time which increases the duration of the surgical intervention. To overcome this drawback, intervertebral wedges have already been proposed consisting of two separate parts. Each part of the wedge is put in place by bypassing the supraspinous ligament and then using suitable surgical instruments, the two parts of the wedge are secured. Such two-part shims are described in particular in US Pat. No. 6,156,038. However, the two-part shims described in this document are of relatively delicate use. In particular, the assembly of the two parts of the wedge in situ is relatively delicate and it is not sure to obtain the assembly of the two parts forming the wedge in a suitable manner. An object of the present invention is to provide an intervertebral wedge consisting of two separate parts whose assembly is easier for the surgeon during the intervention. To achieve this object, according to the invention, the intervertebral implant comprising a wedge constituted by a first and a second part, said parts being provided with mutual assembly means, is characterized in that said assembly means comprise: - first clipping means secured to one of said pieces, - second clipping means secured to the other piece, capable of cooperating with the first clipping means to achieve a clipping-open of the two pieces in a clipping direction, said first and second clipping means forming an integral part of said two parts; and - means for guiding the two parts when they are clipped, said guide means being distinct from the clipping means and comprising: .. a first guide assembly integral with one of said parts and substantially non-deformable; and .. a second guide assembly integral with the other part and substantially non-deformable, to cooperate with the first guide assembly in order to achieve mutual guiding of the two parts in said clipping direction and relative positioning of the two parts in a plane orthogonal to the direction of clipping. We understand that, thanks to the fact that each piece constituting the intervertebral wedge comprises, on the one hand, guide means and on the other hand, clip means, the guide means ensure the relative positioning of the clip means so rigorous and easy for the surgeon. This ensures the correct assembly of the two parts constituting the shim and moreover, this operation can be carried out more quickly than with the shims of the prior art. In addition, as the clipping means are an integral part of the two parts, the placement of the implant by the surgeon is facilitated. According to a preferred embodiment of the invention, each part of the wedge has an assembly face intended to be applied against that of the other part when the two parts are assembled. Also preferably, the guide means consist respectively of two guide pins protruding from one of the assembly faces and by two recesses opening into the assembly face of the other part. This gives effective guidance of one piece with respect to the other by giving the guide pins a suitable shape. Other characteristics and advantages of the invention will appear better on reading the following description of an embodiment of the invention given by way of non-limiting example. The description refers to the appended figures in which: - Figure 1 is an exploded view of the various elements constituting the intervertebral implant; - Figure 2 is a view of the assembly face of one of the two parts constituting the intervertebral wedge; - Figure 3 is a side view of the wedge after the assembly of the two parts constituting it; and - Figure 4 is a longitudinal section of the self-locking element used to secure the braids of the implant. In Figure 1, the two parts 12 and 14 are shown, the assembly of which makes it possible to obtain the intervertebral wedge 10. In this figure, there is also shown a removable element 16 used for fixing and tightening the braids ensuring the joining of the two spinous processes on the hold. This fixing element 16 will be described later. The part 12 constitutes a first flank of the intervertebral wedge. This part 12 has an internal face 12a and an external face 12b. The internal face 12a defines an upper support surface 20, a lower support surface 22 and a middle assembly face 24. The second part 14 also constitutes a sidewall 26 having an internal face 26a facing the internal face 12a of the part 12 and an external face 26b. The internal face 26a of the sidewall 26 defines an upper support surface 28 and a lower support surface 30. In the middle region of the internal face of the sidewall 26, the part 14 has a projection 32 which projects into the central part of face 26a. This projection 32 or spacer defines two respectively upper 34 and lower 36 bearing faces, these two faces being substantially parallel. The spacer 32 may have transverse recesses such as 38 to give this part of the wedge a certain elasticity. The free end of the spacer 32 defines an assembly face 40 intended to come to bear on the assembly face 24 of the part 12 when the two parts constituting the wedge are assembled. In the assembly faces 40 and 24 of the two parts, mutual guide means are provided during the bringing together of these two parts with a view to their joining. Preferably, these guide means consist of two guide pins 42 and 44 projecting from the assembly face 40 of the part 14 and by two blind recesses 46 and 48 formed in the assembly face 24 of the part 12. We would not go beyond the invention if we planned a single pawn and a single recess. Preferably, as is known per se, the ends of the assembly pins 42 and 44 are conical to ensure the initial positioning of the two parts. The attachment of the parts 12 and 14 is obtained by clipping means which are produced respectively in the lateral faces 12c and 12d of the part 12, and in the lateral faces 32a and 32b of the projection 32 of the part 14. These means of clipping, for example for part 12, consists of two pairs of cylindrical pins 49 and 50 and in two flanks projecting beyond the assembly face 44 of part 14, respectively referenced 51 and 52. Each flank is provided two openings 54 and 56 adapted to receive the pins 49 and 50 during the clipping. Each orifice 54, 56 has a deformable spoiler 58 and 60. As also shown in FIG. 1, the pins 49 and 50 protrude into a recess 60 produced in the lateral faces 12c, 12d of the part 12. It should be added that well understood, the guide pins 42 and 44 have a length which is greater than that of the sides 51 and 52 defining the female clip elements. Whatever the particular embodiment of the clipping means, these form an integral part of the two parts 12 and 14 respectively. As best shown in FIG. 3, when the parts 12 and 14 are assembled, in the manner in which the 'will explain later, we obtain an intervertebral wedge having the usual structure. In particular, the bearing faces 20, 22 of the part 12 as well as the bearing faces 28, 30 of the sidewall 26 of the part 14 and finally the upper 34 and lower 36 faces of the extension 32 define two recesses 62 and 64 intended to receive the spinous processes of the two vertebrae between which the wedge is disposed. It should be added that, of course, the guide pins 42 and 44 have a length which is greater than that of the sides 50 and 52 defining the female clipping elements. The mode of use of the wedge described above is as follows. The surgeon sets up, bypassing the supraspinous ligament, the parts 12 and 14 constituting the wedge. With the aid of suitable surgical instruments, it brings the two parts together to make the guide pins 42 and 44 cooperate with the guide recesses 46 and 48. When the resulting relative positioning is achieved, the clipping members 48, 50 and 54, 56 are opposite each other. It suffices for the surgeon to exert pressure on the external faces of the two parts to cause the clipping of the parts 12 and 14, and therefore obtaining the complete shim 10. It should be added that the clipping elements 48, 50 and 54, 56 are made in such a way that they ensure effective clipping but that it is possible to desendip them in the event that it is necessary to change the shim. As can be seen, the positioning of the wedge is easy since it only comprises two parts. Referring now to Figures 1 and 4, we will describe a preferred embodiment of the securing means of the wedge 10 and the spinous processes of the vertebrae. This joining system is constituted by the blocking or joining piece 16 and by two braids T1 and T2. The connecting piece 16 can be fixed on the external face 26b of the piece 14 by clipping means 80, 82, 84 and 86 which are identical to the clipping means of the pieces 12 and 14. The fixing piece 16 has a face 16b on the part 14 and an external face 16a. The fixing piece 16 has a plane of symmetry P, P 'orthogonal to the faces 16a and 16b and parallel to the faces 32 and 34 of the extension 30 of the piece 14. The locking piece 16 has a central slot 90 which opens into the two faces of the part 16 and two symmetrical inclined lateral slots 92 and 94 which also open into the two faces of the part 16. The clipping face 16b of the part 16 has two recessed surfaces 96 and 98 which extend between respectively the lateral slots 92 and 94 and the upper and lower ends of the part 16 which constitute braid tightening surfaces. The slot 92 and the recessed surface 98 define a first edge 100. Likewise, the slot 92 with the external face 16a of the part 16 define a second acute edge 102 parallel to the edge 100. As shown in the figure, the edge 102 is further from the median plane P, P 'than the edge 100. In in addition, it should be specified that the clamping surfaces 96 and 98 are arranged in such a way that when the part 16 is clipped onto the wedge, the distance between the face 26b of the wedge and the surface 96 or 98 is slightly less than twice the thickness of the braids T1 and T2. Each braid T1 and T2 comprises a first end A which is integral with the part 12. For this, in the example considered, the part 12 is provided with an upper slot 104 and a lower slot 106 in which the ends A braids can form a loop. After sewing this loop, the braids Tl and T2 are effectively secured at each end of the part 12. The braid T2 is engaged between the surface 98 and the face 26b of the wedge then in the central slot 90. Then, it passes over a portion of the external face 16a of the part 16 and enters the slot 92 while passing opposite the edge 102. Then, the braid T2 is engaged below the pressure surface 98, between the first strand of that same braid and that surface. When the surgeon exerts traction on the end B of the braid T2, this ensures the tightening of the braid T2 on the spinous process of the upper or lower vertebra. The braid Tl is of course engaged in the part 16 in the same way to ensure the connection with the spinous process of the other vertebra. It is understood that the securing piece 16 forms for each braid a self-locking system. When the surgeon exerts traction on the free end B of the braid, it can move without excessive friction in the slots 90 and 92 until the desired tightening effect is obtained. On the other hand, when no traction is exerted on the end B of the braid, that is to say in normal use of the intervertebral implant, a self-locking effect is obtained thanks to the presence of the edges 100 and 102 and the clamping effect of the pressure surface 98 on the two strands of the braid. According to a preferred embodiment, the first clipping means comprise at least two male clipping members 54 and 56 substantially non-deformable, arranged on either side of the assembly surface 24 and the second clipping means comprise at least two female members 49 and 50 for elastically deformable clipping arranged on either side of the assembly surface 40. Preferably also, said first guide assembly comprises at least one guide pin 42 and 40 projecting in one face d 'assembly 40 of one of the parts and at least one recess 46 and 48 opening into the assembly face 24 of the other part.

Claims

REVENDICATIONS
1. Implant intervertébral comprenant une cale (10) constituée par une première (12) et une deuxième (14) pièce, lesdites pièces étant munies de moyens d'assemblage mutuel, caractérisé en ce que lesdits moyens d'assemblage comprennent : - des premiers moyens de clipsage (54, 56) solidaires d'une desdites pièces, - des deuxièmes moyens de clipsage (49, 50) solidaires de l'autre pièce, aptes à coopérer avec les premiers moyens de clipsage pour réaliser un clipsage désenclipsable des deux pièces selon une direction de clipsage, lesdits premiers et deuxièmes moyens de clipsage faisant partie intégrante des deux pièces ; et - des moyens de guidage des deux pièces lors de leur enclipsage, lesdits moyens de guidage étant distincts des moyens de clipsage et comprenant : .. un premier ensemble de guidage (42, 44) solidaire d'une desdites pièces et sensiblement non déformable ; et .. un deuxième ensemble de guidage (46, 48) solidaire de l'autre pièce et sensiblement non déformable, pour coopérer avec le premier ensemble de guidage afin de réaliser un guidage mutuel des deux pièces selon ladite direction de clipsage et un positionnement relatif des deux pièces dans un plan orthogonal à la direction de clipsage. 1. Intervertebral implant comprising a wedge (10) constituted by a first (12) and a second (14) part, said parts being provided with mutual assembly means, characterized in that said assembly means comprise: - first clipping means (54, 56) integral with one of said parts, - second clipping means (49, 50) integral with the other part, able to cooperate with the first clipping means in order to make a disengageable clipping of the two parts in a clipping direction, said first and second clipping means forming an integral part of the two parts; and - means for guiding the two parts when they are clipped, said guide means being distinct from the clipping means and comprising: .. a first guide assembly (42, 44) integral with one of said parts and substantially non-deformable; and .. a second guide assembly (46, 48) integral with the other part and substantially non-deformable, to cooperate with the first guide assembly in order to achieve mutual guidance of the two parts in said clipping direction and relative positioning of the two parts in a plane orthogonal to the direction of clipping.
2. Implant intervertébral selon la revendication 1, caractérisé en ce que chacune desdites deux pièces (12, 14) comporte une face d'assemblage (24, 40), lesdites faces d'assemblage étant appliquées l'une contre l'autre lorsque les deux pièces sont assemblées. 2. Intervertebral implant according to claim 1, characterized in that each of said two parts (12, 14) has an assembly face (24, 40), said assembly faces being applied one against the other when the two pieces are assembled.
3. Implant intervertébral selon la revendication 2, caractérisé en ce que les premiers moyens de clipsage comprennent au moins deux organes mâles de clipsage (54, 56) sensiblement non deformables, disposés de part et d'autre de la surface d'assemblage (24) et les deuxièmes moyens de clipsage comprennent au moins deux organes femelles (49, 50) de clipsage elastiquement deformables disposés de part et d'autre de la surface d'assemblage (40). 3. Intervertebral implant according to claim 2, characterized in that the first clipping means comprise at least two male clipping members (54, 56) substantially non-deformable, arranged on either side of the assembly surface (24 ) and the second clipping means comprise at least two female members (49, 50) of elastically deformable clipping arranged on either side of the assembly surface (40).
4. Implant intervertébral selon l'une quelconque des revendications 2 et 3, caractérisé en ce que ledit premier ensemble de guidage comprend au moins un pion de guidage (42, 40) faisant saillie dans une face d'assemblage (40) d'une des pièces et au moins un évidement (46, 48) débouchant dans la face d'assemblage (24) de l'autre pièce. 4. Intervertebral implant according to any one of claims 2 and 3, characterized in that said first guide assembly comprises at least one guide pin (42, 40) projecting in an assembly face (40) of a parts and at least one recess (46, 48) opening into the assembly face (24) of the other part.
5. Implant intervertébral selon l'une quelconque des revendications 2 à 4, caractérisé en ce que ledit premier ensemble de guidage comprend deux pions de guidage (42, 44) et le deuxième ensemble de guidage comprend deux évidements (46, 48). 5. Intervertebral implant according to any one of claims 2 to 4, characterized in that said first guide assembly comprises two guide pins (42, 44) and the second guide assembly comprises two recesses (46, 48).
6. Implant intervertébral selon l'une quelconque des revendications 2 à 5, caractérisé en ce que chacune desdites pièces (12, 14) comporte deux moyens de clipsage (49, 50, 54, 56). 6. Intervertebral implant according to any one of claims 2 to 5, characterized in that each of said parts (12, 14) comprises two clip means (49, 50, 54, 56).
7. Implant selon l'une quelconque des revendications 2 à 6, caractérisé en ce que la première (14) desdites deux pièces comporte une face externe (26b) opposée à la face d'assemblage (40) et en ce qu'il comprend en outre : - deux tresses (Ti, T ) de fixation de ladite cale (10) sur deux apophyses épineuses, et - un élément d'autoblocage (16) comportant des moyens de fixation sur la face externe d'une desdites tresses, chaque tresse ayant une première extrémité solidaire de ladite pièce (12, 14) non associée à l'élément d'autoblocage (16) et une deuxième extrémité engageable dans ledit élément d'autoblocage. 7. Implant according to any one of claims 2 to 6, characterized in that the first (14) of said two parts has an external face (26b) opposite the assembly face (40) and in that it comprises in addition: - two braids (Ti, T) for fixing said wedge (10) on two thorny processes, and - a self-locking element (16) comprising means for fixing to the external face of one of said braids, each braid having a first end integral with said part (12, 14) not associated with the self-locking element (16) and a second end which can be engaged in said self-locking element.
EP05769961A 2004-05-11 2005-05-09 Intervertebral implant Ceased EP1744690B1 (en)

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US7588601B2 (en) 2009-09-15
KR20070055418A (en) 2007-05-30
WO2005120369A1 (en) 2005-12-22
US8002805B2 (en) 2011-08-23
FR2870106A1 (en) 2005-11-18
JP2007536965A (en) 2007-12-20
EP1744690B1 (en) 2011-09-14
AU2005251497A1 (en) 2005-12-22
FR2870106B1 (en) 2007-07-27
ZA200610266B (en) 2008-06-25
US20080033556A1 (en) 2008-02-07
US20100016897A1 (en) 2010-01-21
AU2005251497B2 (en) 2011-02-17
JP4495212B2 (en) 2010-06-30

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